HPEX 353 Chapter 7: Mental Health Diseases and Disorders

Bidirectional referrals

•Specialists request physical exams before treating mental disorders; PCPs refer patients for psychotherapy/counseling.

"Recovery" model

Focus on developing functional life skills rather than a medical "cure".

Critical need for integration

•Individuals with severe mental illness often live 10 to 20 years less due to untreated chronic medical conditions

-due primarily to chronic diseases

Psychiatrization

the process by which an ever-expanding assemblage of human life experiences have come to be observed, understood, enacted and acted upon through the language, theories, technologies and institutional practices of western biomedical psychiatry

What are the aspects of psychiatrization?

Material and ideological

Material

growth of psychiatric infrastructures, private or public research institutions, technological, pharmaceutical, or biomedical companies

Ideological

defining or labeling certain conditions or behaviors as mental disorders

The primary framework for Mental Health Diagnostic Procedures

DSM-V

Standardized evaluation

Provides common diagnostic criteria and classifications for clinicians and investigators.

Integrated coding

Utilizes both ICD-9-CM and ICD-10-CM medical codes

What are the examinations that determin mental status?

•Core assessment tool

•Appearance & Motor/Speech

•Mood & Affect

•Thought Content & Perceptions

•Cognitive Functioning

What are the core assessment tool in examining mental status?

Brief question-and-answer and observational exam to identify mental health symptoms.

What do you evaluate regarding appearance & motor/speech?

grooming, posture, physical mannerisms, and speech clarity/speed

How do you evaluate mood & affect?

Assesses emotional state (e.g., sadness, hostility) and evaluates suicide risk/plans.

How do you evaluate thought content and perceptions?

Identifies hallucinations (false sensory perceptions) and delusions (false beliefs).

How do you evaluate cognitive functioning?

Tests level of consciousness, orientation (person/place/time), memory, and basic calculation/judgment

Nature (Biological/Genetic)

•Inherent traits; chromosomal variations show high heritability for schizophrenia, bipolar disorder, major depression, ASD, and ADHD. Difficult or impossible to alter.

Nurture (Environmental)

Impact of caregiver influence, surroundings, and traumatic events.

Adverse Childhood Experiences (ACEs)

Studies show childhood trauma significantly increases lifelong risk for mental health and substance use disorders

Factors that affect mental health

•Culture & Race: Symptom presentation often reflects cultural belief systems; treatment access can be delayed by community stigma or immigrant alienation.

•Age Factors: spans all ages; pediatric drug/alcohol issues seen as early as age 8; geriatric mental health often dangerously ignored as "normal aging".

•Gender Bias: Many disorders afflict women more often; men are more likely to restrict their own treatment due to perceived stigma.

•LGBTQI Populations: Face significantly higher risks for mental health disorders, depression, and suicide.

•Stigma Impact: Stigma and discrimination universally exert negative impacts on overall physical and mental health

Description of Depressive Illness

•Sadness, emptiness, lack of motivation; includes major depressive, peripartum onset, seasonal pattern, and persistent depressive disorders.

Causes/risk factors of Depressive Illness

•Brain structure/function changes, genetics (serotonin regulation), secondary medical conditions, medication side effects, stress, female gender.

Signs/symptoms of Depressive Illness

Predominantly sad mood, apathy, fatigue, insomnia, appetite fluctuations, delusions, suicidal thoughts

Diagnostic Criteria of Depressive Illness

Multiple symptoms present over 2-week period; marked change from previous functioning; rule out other physical health issues.

Treatments of Depressive Illness

Antidepressants (SSRIs, SNRIs, TCAs, MAOIs), psychotherapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), lifestyle modifications.

Prognosis of Depressive Illness

Good for mild/moderate cases; severe cases potentially requiring lifelong treatment; high suicide risk

Description of Bipolar Disorder

•Altered sensory perception, brain functioning, and behavior; forms include catatonia and schizoaffective disorder.

Causes/risk factors of Bipolar Disorder

•Genetics (up to 80% heritability), psychodynamic neurobiological deviations, severe stress (diathesis stress theory).

Signs/symptoms of Bipolar Disorder

Positive symptoms (hallucinations, delusions, disorganized speech); negative symptoms (flat affect, alogia, avolition).

Diagnostic Criteria of Bipolar Disorder

Two or more symptoms for at least 1 month (must include delusions, hallucinations, or disorganized speech); psych evaluation, lab tests, imaging.

Treatments of Bipolar Disorder

Psychotropic medications (atypical antipsychotics), psychotherapy, counseling, stress management, structured group homes.

Prognosis of Bipolar Disorder

Varies widely; most improving with medication but many experiencing long-term functional disability and acute relapses

Description of Anxiety Disorders

•Unrealistic anticipation of fear; includes generalized anxiety (GAD), panic disorder, obsessive-compulsive disorder (OCD), phobias, hoarding.

Causes/risk factors of Anxiety Disorders

•Combination of psychological and biological factors; intrapsychic/interpersonal conflict, major depression, distressful events, genetics.

Signs/symptoms of Anxiety Disorders

•Severe apprehension, muscle tension, heart palpitations, irrational fears, ritualistic repetitive behaviors.

Diagnostic Criteria of Anxiety Disorders

•Persistent inability to function properly in society, work, and relationships due to symptoms.

Treatments of Anxiety Disorders

•Cognitive behavioral therapy (CBT), antianxiety meds, antidepressants, beta blockers, short-term benzodiazepines, desensitization therapy.

Prognosis of Anxiety Disorders

Good when learning to cope via diversions or effective desensitization

Description of Trauma and Stressor-related Disorders

Persistent psychological consequences lasting over 1 month following a traumatic event (war, assault, accidents)

Causes/risk factors of Trauma and Stressor-related Disorders

Exposure to trauma; involvement of brain chemicals (serotonin, stathmin) and amygdala fear responses

Signs/symptoms of Trauma and Stressor-related Disorders

Exposure to trauma; involvement of brain chemicals (serotonin, stathmin) and amygdala fear responses

Diagnostic Criteria ofTrauma and Stressor-related Disorders

At least one flashback/nightmare, three avoidant symptoms, two emotional response changes causing functional difficulty

Treatments of Trauma and Stressor-related Disorders

Psychotherapy (CBT, EMDR), antidepressants (SSRIs), antianxiety medications, prazosin for nightmares

Prognosis of Trauma and Stressor-related Disorders

Chronic if lasting >3 months; symptoms potentially lessening over time but complete recovery unlikely

Description of Personality Disorders

•Inflexible, maladaptive behavior preventing healthy relationships; includes antisocial, borderline, narcissistic, and avoidant types.

-Antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, avoidant personality disorder

Causes/risk factors of Personality Disorders

Unclear origins; potential genetic link, developmental factors (child abuse, early parental separation), sociocultural alienation

Signs/symptoms of Personality Disorders

Maladaptive environmental interactions, provoking negative reactions from others, withdrawal, lack of resilience

Diagnostic Criteria of Personality Disorders

Difficulties in 2+ areas (cognitive, affectivity, impulse control, interpersonal); pattern established since childhood/adolescence

Treatments of Personality Disorders

Consistent structured therapy (moral recognition, dialectical behavior therapy), family involvement; meds only for acute co-occurring symptoms

Prognosis of Personality Disorders

Dependent on type/severity; some diminishing with age, others requiring lifelong treatment; high suicide risk in borderline personality

Description of Substance-related and Addictive Disorders

Physical and psychological dependence on alcohol or psychoactive drugs; characterized by tolerance and withdrawa

Causes/risk factors of Substance-related and Addictive Disorders

Genetics (50-60% for alcohol), biochemical/endocrine imbalances, psychological urge to reduce anxiety, sociocultural norms/peer pressure

Signs/symptoms of Substance-related and Addictive Disorders

Genetics (50-60% for alcohol), biochemical/endocrine imbalances, psychological urge to reduce anxiety, sociocultural norms/peer pressure

Diagnostic Criteria of Substance-related and Addictive Disorders

Client history, self-reporting, early prescription depletion, toxicology screens for blood/urine

Treatments of Substance-related and Addictive Disorders

Total abstinence, detoxification; medications (naltrexone, methadone, nicotine replacement), CBT, motivational interviewing

Prognosis of Substance-related and Addictive Disorders

No cure; high relapse rate (40-60%); recovery possible with long-term abstinence and constructive lifestyle replacements

Description of Intellectual Disability

Significantly below-average intellectual functioning with adaptive behavior deficits appearing before age 8

Causes/risk factors of Intellectual Disability

Unknown in 50%; potential prenatal (hydrocephalus), chromosomal (trisomy 21), metabolic, environmental, or trauma factors

Signs/symptoms of Intellectual Disability

Developmental delays, severe cognitive/motor impairment, learning disabilities

Diagnostic Criteria of Intellectual Disability

Deficient in 2+ areas (self-care, communication, social, academic, etc.) prior to age 18; psych evaluation

Treatments of Intellectual Disability

Team approach building on strengths; special education, adaptive/motor skill development, strong support networks

Prognosis of Intellectual Disability

Dependent on severity and training availability; many living productive, happy lives

Description of Autism Spectrum Disorders

Pervasive developmental disorder causing social deficits and restricted repetitive behaviors. Exists on a severity scale (I-III)

Causes/risk factors of Autism Spectrum Disorders

No direct known cause; Related factors: genetic links, environmental factors, viral infections, labor/delivery issues

Signs/symptoms of Autism Spectrum Disorders

Poor eye contact, repetitive behaviors, echolalia, sensory problems, lack of emotional response or emotional regulation inability, Commonly seen in early childhood: deficits in social aspects, repetitive behavior, learning/intellectual disabilities* (in most severe stage).

Diagnostic Criteria of Autism Spectrum Disorders

•Screening/observation by parents, teachers, medical providers starting around 18 months, usually diagnosed by age 2 to 3.

*Per DSM5, must satisfy these criteria: A) social-emotional reciprocity, nonverbal communication, relationship difficulties, and at least 2 of the B: B) stereotyped/repetitive movements, inflexibility, highly fixated interests, sensory issues. C)Symptoms must be present in early development, D) cause clinically significant impairment in social, occupational, or other area of functioning, and E) can't be explained by other conditions.

Treatments of Autism Spectrum Disorders

Intensive early intervention, structured educational programs, intensive behavioral/communication therapies

Prognosis of Autism Spectrum Disorders

No cure; early diagnosis significantly increasing likelihood of symptom management into adulthood

Description of Attention-Deficit Hyperactivity Disorder (ADHD)

Common neurobiological disorder featuring inattention, impulsivity, and hyperactivity

Causes/risk factors of Attention-Deficit Hyperactivity Disorder (ADHD)

Environmental (lead, food additives), genetics, prenatal/perinatal complications, lower brain glucose activity

Signs/symptoms of Attention-Deficit Hyperactivity Disorder (ADHD)

Distractibility, extreme fidgeting, excessive talking, carelessness, impatience

Diagnostic Criteria of Attention-Deficit Hyperactivity Disorder (ADHD)

Symptoms (distractibility, impulsivity, hyperactivity) must be excessive, long-term (>6 months), appearing before age 12, causing hardship in 2+ settings (home, school, social).

Treatments of Attention-Deficit Hyperactivity Disorder (ADHD)

Psychotropic stimulants, behavior management, cognitive therapy, social skills development

Prognosis of Attention-Deficit Hyperactivity Disorder (ADHD)

Continuing into adulthood for many; affects job/relationships; reasonable workplace accommodations helpful for productivity

Description of Feeding and Eating Disorders (Anorexia and Bulimia)

Anorexia (self-imposed starvation, irrational fear of weight gain); Bulimia (repetitive gorging followed by self-induced vomiting/purging).

Causes/risk factors of Feeding and Eating Disorders (Anorexia and Bulimia)

Genetic components, serotonin abnormalities, psychological struggle for control, sociocultural beauty standards, family conflict

Signs/symptoms of Feeding and Eating Disorders (Anorexia and Bulimia)

Genetic components, serotonin abnormalities, psychological struggle for control, sociocultural beauty standards, family conflict

Diagnostic Criteria of Feeding and Eating Disorders (Anorexia and Bulimia)

Loss of 25% original body weight without medical cause (anorexia); physical exams, blood testing, electrolyte studies

Treatments of Feeding and Eating Disorders (Anorexia and Bulimia)

Aggressive medical management, nutritional counseling, psychotherapy, antidepressants (especially for bulimia), possible hospitalization

Prognosis of Feeding and Eating Disorders (Anorexia and Bulimia)

Frequent relapses; potentially fatal due to malnutrition/cardiac issues (anorexia) or high suicide incidence (bulimia)

Description of Sexual Dysfunctions

Disturbances in sexual desire and response cycle (Genito-Pelvic Pain, Erectile Disorder, Female Arousal Disorder, Premature Ejaculation)

Causes/risk factors of Sexual Dysfunctions

Psychological (anxiety, depression, trauma) and physiological (diabetes, vascular disease, hormonal imbalances, nerve damage, lesions, infections, abnormal growths, retroversion of uterus, etc.).

Signs/symptoms of Sexual Dysfunctions

Pain during intercourse, inability to achieve/sustain erection or vaginal lubrication/vasocongestive response, lack of physical arousal, early ejaculation, anorgasmia

Diagnostic Criteria of Sexual Dysfunctions

Detailed sexual history, physical/pelvic exams, neurological/urological evaluations

Treatments of Sexual Dysfunctions

Correction of physiological issues, psychotherapy, sex therapy, specific medications (e.g., sildenafil, SSRIs), use of lubricants

Prognosis of Sexual Dysfunctions

Generally good with proper treatment, open partner communication, and sensitivity